Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019

Marlieke E A De Kraker,Ermira Tartari,Sara Tomczyk,Anthony Twyman,Laurent C Francioli,Alessandro Cassini,Benedetta Allegranzi,Didier Pittet

doi:10.1016/s1473-3099(21)00618-6

Abstract

SummaryBackgroundHand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.MethodsFrom Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation.Findings3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248–430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55–100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35–75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated.InterpretationMost health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all.FundingWHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.

Highlights

Health-care-associated infections (HAIs) affect the quality of health-care services, jeopardising patient safety and increasing health-care costs
We identified one international report, from WHO, using the Hand Hygiene Self-Assessment Framework, which reported data from surveys in 2011 (2119 health-care facilities, 69 countries) and 2015 (807 health-care facilities, 91 countries), focused on the status of hand hygiene programmes and the progress of hand hygiene implementation over time of only 86 health-care facilities
Implications of all the available evidence This study shows that most participating health-care facilities have an intermediate level of hand hygiene implementation or higher, this was positively associated with country income level and health-care facility funding structure

Summary

Introduction

Health-care-associated infections (HAIs) affect the quality of health-care services, jeopardising patient safety and increasing health-care costs. Up to 2·6 million HAIs occur every year in the EU and European Economic Area (approximately 500 per 100 000 inhabitants), resulting in more than 91 000 deaths.. In the USA, 1·7 million HAIs (approximately 520 per 100 000 inhabitants) are reported annually, resulting in about 99 000 deaths.. For regions with a greater number of low-income and middleincome countries, data are scant, but available evidence suggests that the incidence of HAIs is higher, and health and economic consequences more dire.. Hand hygiene compliance has become one of the key performance indicators of patient safety and quality of health services world wide.. Overall, hand hygiene compliance remains insufficient, and compliance levels as low as 9% have been reported for health-care facilities from lowincome countries.. Hand hygiene compliance has become one of the key performance indicators of patient safety and quality of health services world wide. overall, hand hygiene compliance remains insufficient, and compliance levels as low as 9% have been reported for health-care facilities from lowincome countries. levels for high-income countries are generally higher, they rarely exceed 70%.8

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